Tennessee - Integrated Employment — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Tennessee Department of Disability and Aging (DDA) credentials agencies to deliver Integrated Employment services through the Employment and Community First (ECF) CHOICES program and legacy 1915(c) waivers. Applicants must first submit a New Provider Credentialing Application to DDA and secure an approved credentialing status before they are permitted to enroll in the TennCare Medicaid Management Information System (MMIS) or contract with the state's Managed Care Organizations (MCOs).

Funding for job development, placement, and on-site coaching is bifurcated between TennCare's Medicaid waiver programs and the Department of Human Services (DHS) Vocational Rehabilitation (VR) program. Providers seeking to offer comprehensive employment supports typically must dual-enroll as a DDA-credentialed Medicaid provider and a DHS Community Rehabilitation Provider (CRP) to ensure continuity of funding, as Medicaid requires exhaustion of VR benefits before authorizing ECF CHOICES employment services.

1. Service Definition and Scope

In Tennessee, Integrated Employment encompasses services that assist individuals with intellectual and developmental disabilities in obtaining and maintaining competitive, integrated employment at or above the state minimum wage. Under the ECF CHOICES program, this is categorized into distinct phases including Exploration, Discovery, Job Development, and Job Coaching.

These services are designed to be person-centered and outcome-driven, ensuring that individuals work in community settings alongside non-disabled peers.

• Exploration: Time-limited service to help individuals determine if they want to pursue competitive integrated employment.
• Discovery: Time-limited, customized employment process to identify the person's unique strengths, interests, and conditions for success.
• Job Development: Assistance in obtaining a specific competitive integrated job matching the individual's skills and interests.
• Job Coaching: On-site supports provided to the individual to learn and maintain job duties.
• Competitive Wage: Employment must pay at or above the prevailing minimum wage and not less than the customary wage paid by the employer for the same work.
• Integration: Work must occur in a setting where the individual interacts with persons without disabilities to the same extent as workers without disabilities.

2. Regulatory and Oversight Agencies

The primary oversight for Medicaid-funded employment services is shared between the Bureau of TennCare and the Department of Disability and Aging (DDA). TennCare manages the overarching Medicaid authority and MCO contracts, while DDA handles direct provider credentialing and quality assurance.

The Department of Human Services also plays a critical role for providers delivering initial vocational assessments and placements.

• Department of Disability and Aging (DDA): Credentials HCBS providers and conducts quality surveys (https://www.tn.gov/disability-and-aging.html)
• Bureau of TennCare: Serves as the Single State Medicaid Agency overseeing ECF CHOICES (https://www.tn.gov/tenncare.html)
• Department of Human Services (DHS) Vocational Rehabilitation: Administers the Community Rehabilitation Provider (CRP) program (https://www.tn.gov/humanservices/ds/vocational-rehabilitation.html)
• Amerigroup (Wellpoint) Tennessee: Managed Care Organization administering ECF CHOICES benefits (https://provider.amerigroup.com/tennessee-provider/home)
• BlueCare Tennessee: Managed Care Organization administering ECF CHOICES benefits (https://bluecare.bcbst.com/providers)
• UnitedHealthcare Community Plan of Tennessee: Managed Care Organization administering ECF CHOICES benefits (https://www.uhcprovider.com/en/health-plans-by-state/tennessee-health-plans/tn-comm-plan-home.html)

3. Gatekeeping Prerequisites: Who Can Even Apply

Tennessee utilizes a closed-loop credentialing and MCO contracting model for ECF CHOICES. A prospective provider cannot simply enroll in Medicaid; they must first pass DDA's credentialing review and then secure network contracts with at least one of the three TennCare MCOs.

Additionally, the interplay between Medicaid and Vocational Rehabilitation creates structural prerequisites for service delivery.

• DDA Credentialing Approval: Required prior to Medicaid enrollment; applicants must submit the New Provider Credentialing Application to [email protected].
• MCO Network Need: MCOs (Amerigroup, BlueCare, UHC) may close their networks to new employment providers if they determine adequate network capacity exists in a specific grand division (West, Middle, East).
• Vocational Rehabilitation Exhaustion: Medicaid rules require that individuals exhaust available DHS VR services before ECF CHOICES funds Job Development, effectively requiring providers to also hold a VR CRP Letter of Agreement to serve individuals seamlessly.
• Business Registration: Applicants must be registered to do business with the Tennessee Secretary of State prior to submitting a DDA application.
• Financial Solvency: DDA credentialing requires submission of tax forms (W-9, IRS 147c) and evidence of financial stability.

4. Licensure and Certification Requirements

Tennessee does not issue a standalone "Integrated Employment License." Instead, agencies providing these services under Medicaid waivers must be credentialed by DDA as an HCBS provider for specific employment service categories.

If the agency also provides personal care or facility-based day services, they may require a Personal Support Services Agency (PSSA) or Adult Day Care license from the Department of Health or DDA, but community-based employment coaching alone relies on the DDA credentialing process.

• DDA Provider Credentialing: Serves as the primary operating authority for ECF CHOICES employment providers in lieu of a facility license.
• CRP Certification: Required by DHS for agencies providing Job Shadowing and Integrated Work Site Assessments under VR funding.
• PSSA Licensure: Required only if the agency also provides personal assistance services alongside employment supports.
• Credentialing Forums: Prospective providers are expected to attend DDA Provider Credentialing Forums (held quarterly) prior to application submission.
• Regional Designation: Applications must specify the requested operating region (West, Middle, East, or Statewide).

5. Medicaid Provider Enrollment

Once credentialed by DDA, providers must enroll with the Bureau of TennCare to receive a Medicaid ID. This is processed through the TennCare Provider Registration portal.

Following TennCare enrollment, providers must complete the credentialing and contracting process with the individual MCOs.

• TennCare Provider Registration Portal: The online system used to submit the Medicaid enrollment application (https://pdms.tenncare.tn.gov).
• Medicaid ID Issuance: TennCare issues a Medicaid ID upon successful enrollment, which is required to execute MCO contracts.
• Abbreviated Medicaid Agreement: HCBS waiver providers must sign this agreement during the TennCare enrollment process.
• MCO Contracting: After receiving a Medicaid ID, providers must apply to join the networks of Amerigroup, BlueCare, and/or UnitedHealthcare.
• Council for Affordable Quality Healthcare (CAQH): MCOs utilize CAQH ProView for credentialing data collection during the contracting phase.

6. Staffing, Training and Background Checks

DDA and TennCare mandate specific competency-based training for employment specialists. Direct support professionals (DSPs) providing job coaching must meet baseline HCBS requirements, while staff performing Job Development or Discovery must hold advanced certifications.

All staff must clear rigorous background and registry checks prior to client contact.

• Employment Specialist Certification: Staff conducting Discovery or Job Development must hold a Certified Employment Support Professional (CESP) credential or complete an ACRE-approved basic training certificate.
• Baseline DSP Training: All job coaches must complete CPR, First Aid, and DDA-mandated abuse/neglect prevention training prior to independent service delivery.
• Background Checks: Agencies must conduct Tennessee Bureau of Investigation (TBI) or FBI fingerprint background checks on all direct care staff.
• Registry Clearances: Staff must be cleared against the Tennessee Department of Health Abuse Registry and the National Sex Offender Registry.
• Medication Administration: If a job coach assists with medication at the worksite, they must complete the DDA-approved medication administration training taught by a certified RN.

7. Documentation, Policies and Records

Providers must maintain comprehensive records demonstrating service delivery, progress toward employment goals, and compliance with HCBS settings rules.

Documentation must align with the individual's Person-Centered Support Plan (PCSP) and meet the specific requirements of the funding source.

• Person-Centered Support Plan (PCSP): All employment services must be explicitly authorized and detailed in the member's PCSP.
• Vendor Authorizations: For VR-funded services, providers must sign and submit Vendor Authorizations (manually or via AwareSign) to certify service completion.
• Progress Notes: Daily or per-shift documentation detailing the specific coaching interventions provided and the individual's response.
• Employment Outcomes Reporting: Providers must track and report data on wages, hours worked, and job retention to DDA and the MCOs.
• HCBS Settings Compliance: Policies must document how the provider ensures the individual is integrated into the broader community and has access to the same resources as non-disabled peers.

8. Billing, Rates and Claims

Reimbursement for Integrated Employment in ECF CHOICES is managed through the MCOs, not directly by TennCare. Rates are established by TennCare and published in the ECF CHOICES rate schedule.

Providers must carefully navigate the payer sequence, ensuring VR funds are billed when appropriate before submitting claims to Medicaid MCOs.

• MCO Claims Submission: Claims are submitted directly to the member's assigned MCO (Amerigroup, BlueCare, or UHC) via their respective clearinghouses.
• Rate Schedule: TennCare sets the maximum allowable rates for ECF CHOICES services; providers must consult the current TennCare ECF CHOICES rate schedule for specific fee amounts.
• HCPCS Codes: Services are billed using standard codes (e.g., H2023 for Supported Employment, T2019 for Job Coaching) as defined in the MCO provider manuals.
• VR Payment Structure: DHS VR pays for initial assessments and job placement milestones based on the CRP Service Guide fee schedule.
• Payer of Last Resort: Medicaid claims will be denied if the service is covered by VR and the provider has not obtained a VR denial or exhaustion notice.

9. Approval Sequence and Timeline

The end-to-end process from initial application to billing the first claim typically spans 6 to 9 months. This timeline is heavily dependent on DDA's credentialing queue and the subsequent MCO contracting cycles.

Providers must complete each step sequentially, as approvals from one agency are required to initiate the next phase.

• Step 1: Attend a DDA Provider Credentialing Forum (held quarterly).
• Step 2: Submit the New Provider Credentialing Application and required attachments to [email protected].
• Step 3: DDA Application Review (DDA emails confirmation within 2 business days; providers must wait 30 days before requesting status).
• Step 4: TennCare Medicaid Enrollment via the PDMS portal (typically 30-60 days).
• Step 5: MCO Credentialing and Contracting (can take 90-120 days per MCO).
• Step 6: DHS VR CRP Registration (concurrent process if seeking VR funding).

10. Common Denials and Survey Findings

Applications and claims are frequently delayed or denied due to incomplete documentation or failure to adhere to the strict sequencing of funding sources.

DDA quality surveys heavily scrutinize staff training records and HCBS settings compliance.

• Application Rejection: Failing to label uploaded documents correctly or omitting the region in the subject line of the DDA application email.
• Claims Denial (VR Exhaustion): Billing ECF CHOICES for Job Development without documenting that DHS VR services were exhausted or denied.
• Survey Finding (Staff Qualifications): Allowing staff to perform Discovery or Job Development without the required ACRE or CESP certification on file.
• Survey Finding (Medication): Unlicensed job coaches assisting with medication without current DDA RN-certified training documentation.
• Claims Denial (Prior Authorization): Providing services before the MCO has issued a formal prior authorization linked to the PCSP.

11. Key Contacts and Resources

Prospective providers should utilize the official state portals and manuals to navigate the credentialing and enrollment process.

The DDA Provider Enrollment Coordinator is the primary point of contact for initial applications.

• DDA Provider Enrollment Coordinator: [email protected] or (615) 532-6530
• DDA Provider Credentialing Page: https://www.tn.gov/disability-and-aging/provider-information/become-a-credentialed-provider.html
• TennCare Provider Registration Portal: https://pdms.tenncare.tn.gov
• DHS Vocational Rehabilitation CRP Guide: https://www.tn.gov/humanservices/ds/vocational-rehabilitation.html
• Amerigroup (Wellpoint) Provider Services: 800-454-3730 (https://provider.amerigroup.com/tennessee-provider/home)
• TennCare ECF CHOICES Information: https://www.tn.gov/tenncare/long-term-services-supports/employment-and-community-first-choices.html

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